Prevalence and Determinants of Substance Abuse Among Slum Dwellers in Islamabad- Pakistan

Abstract

Background: In Pakistan, slums are illegal settlements that are always left out in health surveys. However, studies around the world show that substance or drug abuse is higher among slum dwellers and may have different patterns and determinants which need to be studied in order to frame targeted programs and policies. The present study was aimed at estimating the magnitude, as well as determinants of substance/drug abuse among slum dwellers in Islamabad, the capital city of Pakistan. Methods:A community-based cross-sectional study was conducted among the residents of slums/nomadic settlements of Islamabad. A population of 207 individuals was calculated as the appropriate sample size. Both female and male participants aged 15 years and above, from 9 randomly selected slum clusters in Islamabad provided their consent to participate in the study. From each cluster, 23 households were selected, and from each household one individual was randomly selected for estimating the prevalence of substance abuse. All those who were abusing substances were counted as cases and others as controls for case-control analysis. A structured questionnaire was used to gather information on demographics, trends, types of substances abused, risk factors for getting engaged in substance abuse, whether they had tried to quit at any stage, and what difficulties they faced when trying to quit. Results were entered and analyzed using Epi-info version 7.2. Results: A total of 204 participants were enrolled in this study. Among these, 68 (33.3%) were substance or drug abusers. Bivariate analysis of the risk factors indicated that easy access to drugs in slum areas (OR: 20.3, p= 0.000), exposure to tobacco smoking (OR: 8.8, p= 0.000), and being a working child (OR: 6.0, p= 0.000), were strong predictors of substance abuse. Education (OR: 0.2, p= 0.000), and living with own parents during childhood (OR: 0.7 p= 0.2) had protective effects against substance abuse. Conclusion and Implications for Translation: The study concluded that the following were the determinants of substance/drug abuse among the slum dwellers in the study: easy access to drugs, high rate of tobacco consumption, poverty, illiteracy, and being a working-child. Specific policies and plans focusing on law enforcement for curbing the illegal drug sales and reduction of child labor, along with the provision of education, should be devised and implemented to help these neglected communities and modify the identified determinants.